Recognizing and managing hydrocephalus in children.

Hydrocephalus is one of the most common indications for pediatric neurosurgical intervention and is associated with the need for lifelong monitoring. All clinicians should be familiar with the complications that may arise throughout life in these patients so that they can provide timely intervention. This article focuses on the assessment of hydrocephalus, the appropriate diagnostic workup and differential diagnoses, and evidence-based surgical treatments and associated outcomes.

Updates on the diagnosis and management of celiac disease.

Celiac disease is a chronic autoimmune enteropathy affecting about 1% of the population. Gluten ingestion triggers an immune response in genetically susceptible patients, resulting in intestinal and extraintestinal disease manifestations. Current recommendations for diagnosis include serology for celiac-specific antibodies to transglutaminase, endomysium, and deamidated gliadin, and IgA serology.

Fecundity in transgender men.

Premenopausal transgender men who retain internal female reproductive organs, who use exogenous testosterone, and who are sexually active with cisgender men are often capable of conception. This article discusses the potential for fecundity in transgender men, as well as appropriate reproductive care depending on whether the patient prefers to avoid conception or to become pregnant.

Understanding gastroesophageal reflux disease in children.

Gastroesophageal reflux disease (GERD) is a common disorder with increasing prevalence in children. The diagnosis and management of GERD remains a challenge because of its nonspecific symptomatology from infancy through adolescence. Certain presenting alarm symptoms warrant a further, more extensive workup.

The importance of protein intake and strength exercises for older adults.

Sarcopenia, the progressive deterioration of muscle mass, quality, and strength, is prevalent among older adults. Since the first Baby Boomers reached age 65 years in 2010, primary care providers have faced a challenge to address sarcopenia in this growing older population. Preventing sarcopenia is essential for reducing falls, preventing chronic disease, and improving longevity.

Nonpharmacologic options for treating irritable bowel syndrome.

Irritable bowel syndrome (IBS) is a chronic functional disorder with no organic cause. Risk factors are multifactorial and treatment typically consists of antimotility or stimulant laxatives and antidepressants. This article reviews several newer areas of interest: probiotics, fecal microbiota transplant, a low FODMAP diet, and cognitive behavioral therapy.

Recognizing, diagnosing, and treating pediatric generalized anxiety disorder.

Generalized anxiety disorder (GAD), characterized by excessive worry or apprehension, can lead to significant distress or impairment in patients' social or occupational function but commonly is overlooked by primary care providers. GAD and other anxiety disorders are among the most common mental health disorders affecting children. Without treatment, children with GAD are at higher risk for academic underperformance, substance abuse, other mental health disorders, and poor outcomes in adulthood.

Lumbar hernia after iliac crest bone harvest.

A lumbar hernia is a rare occurrence, with about 300 cases reported in the literature since the first publication by Garengeot in 1731. Incisional lumbar hernias are defined as secondary acquired hernias that can develop after surgeries such as nephrectomies or aortic aneurysm repairs. Harvesting bone from the iliac crest also has been identified as a cause of incisional lumbar hernias, occurring after about 0.

Nontuberculous mycobacteria infection risk in medical tourism.

The increasing popularity of medical tourism among US citizens has led to the rising incidence of nontuberculous mycobacteria (NTM) infections from cosmetic surgery performed in other countries. Clinicians must be aware of these infections and the potential difficulties in treating them. The most common NTM species isolated from cutaneous infections in medical tourists is Mycobacterium abscessus.

What are the cardiovascular effects of the newer classes of drugs for type 2 diabetes?

New classes of drugs to treat type 2 diabetes are continually being developed and marketed. The FDA has issued guidance to the pharmaceutical industry that newer hypoglycemic agents should not be associated with unacceptable increases in cardiovascular risk. To date, five trials have assessed specific cardiovascular endpoints for these newer agents.

A nonpharmacologic approach to managing insomnia in primary care.

Insomnia, or inadequate or poor sleep leading to significant distress or impairment in functioning, is a prevalent disorder treated by primary care providers (PCPs). With millions of people across the United States suffering from insomnia, PCPs must understand the disorder's pathophysiology, perpetuating factors, and treatment, as well as its effect on patient health and the economy. Although PCPs traditionally treat insomnia with pharmaceuticals, behavioral measures are effective and should be used whenever possible.

An introduction to gastrointestinal tract CMV disease.

Cytomegalovirus (CMV) causes chronic infection that can manifest disease in many organs. The gastrointestinal (GI) tract is a common location for CMV disease. This article reviews the signs, symptoms, diagnosis, treatment, and prevention of GI CMV disease.

PAs: Fifty years young.

The PA profession is 50 years young. Practicing PAs and current students hail from several generational categories ranging from Builders to Generation Z. This article reviews how different generations may have experienced PA program expansion, professional identity, state licensing, and prescription delegation.

Diabetic ketoacidosis: Heralding type 1 diabetes in children.

Despite advances in diabetes management, diabetic ketoacidosis (DKA) continues to be a leading cause of morbidity and mortality. Up to one-third of children may present with DKA as the original presentation of type 1 diabetes. These children develop clinical manifestations of DKA including hyperglycemia, acidosis, and ketosis.

New Jersey PA regulation and the march on Trenton.

New Jersey was the next to the last state to recognize physician assistants (PAs) and pass legislation allowing them to practice. This first-person account supported by interviews with those who were there details the trail to NJ licensure, including the development of a state society, the growth of support from strong leaders in the medical and academic communities, and the grassroots efforts of many PAs aspiring to work in their home state.

Pediatric temporal bone rhabdomyosarcoma.

Rhabdomyosarcoma is one of the most common soft-tissue sarcomas in children. Prompt diagnosis and treatment significantly improve survival; however, misdiagnosis is common because of this aggressive temporal bone lesion's similarity to more common benign diseases. Clinicians should maintain a high index of suspicion for rhabdomyosarcoma in patients with a presumed otologic infection not responsive to medical therapy.

Benign prostatic hyperplasia: A clinical review.

Benign prostatic hyperplasia (BPH) is an increasingly common diagnosis seen in men over age 50 years. Primary care providers must be aware of patient presentation, diagnostic tests, appropriate lifestyle modifications, treatment options, and potential complications in order to properly manage and educate patients with BPH. If left untreated, BPH can significantly decrease a man's quality of life; however, many pharmacologic and surgical treatments are available to control the symptoms.

Managing hyponatremia in adults.

Hyponatremia can be challenging to manage, especially in older adults. Acute severe hyponatremia can cause significant morbidity and mortality, but too-rapid reversal of chronic hyponatremia can cause serious neurologic issues or death. This article reviews the causes, presentations, and management of hyponatremia in adults.

Acute respiratory distress syndrome: an overview for physician assistants.

An acute, diffuse, inflammatory lung injury, acute respiratory distress syndrome (ARDS) affects up to 10% of patients in the ICU and leads to multiorgan failure and death in nearly half the patients affected. This article reviews the causes, signs and symptoms, and treatment of ARDS.

How to recognize and treat childhood leukemia.

Acute leukemia may be difficult to diagnose in children because of the lack of specific findings. The key is to recognize unexplained symptoms and consider leukemia as a differential. Prompt treatment improves outcomes.